Agency Information Collection Activities: Proposed Request and Comment Request, 40121-40124 [2019-17281]

Download as PDF 40121 Federal Register / Vol. 84, No. 156 / Tuesday, August 13, 2019 / Notices (Catalog of Federal Domestic Assistance Number 59008) Rafaela Monchek, Acting Associate Administrator for Disaster Assistance. [FR Doc. 2019–17275 Filed 8–12–19; 8:45 am] BILLING CODE 8026–03–P SOCIAL SECURITY ADMINISTRATION [Docket No: SSA–2019–0034] Agency Information Collection Activities: Proposed Request and Comment Request The Social Security Administration (SSA) publishes a list of information collection packages requiring clearance by the Office of Management and Budget (OMB) in compliance with Public Law 104–13, the Paperwork Reduction Act of 1995, effective October 1, 1995. This notice includes one new, one extension, and revisions of OMBapproved information collections. SSA is soliciting comments on the accuracy of the agency’s burden estimate; the need for the information; its practical utility; ways to enhance its quality, utility, and clarity; and ways to minimize burden on respondents, including the use of automated collection techniques or other forms of information technology. Mail, email, or fax your comments and recommendations on the information collection(s) to the OMB Desk Officer and SSA Reports Clearance Officer at the following addresses or fax numbers. (OMB) Office of Management and Budget, Attn: Desk Officer for SSA, Fax: 202–395–6974, Email address: OIRA_Submission@omb.eop.gov. (SSA) Social Security Administration, OLCA, Attn: Reports Clearance Director, 3100 West High Rise, 6401 Security Blvd., Baltimore, MD 21235, Fax: 410–966–2830, Email address: OR.Reports.Clearance@ssa.gov. Or you may submit your comments online through www.regulations.gov, referencing Docket ID Number [SSA– 2019–0034]. I. The information collection below is pending at SSA. SSA will submit it to OMB within 60 days from the date of this notice. To be sure we consider your comments, we must receive them no later than October 15, 2019. Individuals can obtain copies of the collection instruments by writing to the above email address. Advance Representative Payee Representative Payee Supporting Statement for Advance Designation of Representative Payee—0960–NEW. On April 13, 2018, the President signed into law The Strengthening Protections for Social Security Beneficiaries Act of 2018, also known as Public Law 115– 165. Section 201 of the law allows SSA beneficiaries and applicants under Title II, Title VIII and Title XVI, of the Social Number of responses jspears on DSK3GMQ082PROD with NOTICES Modality of completion Secuirty Act (Act) to designate individuals to serve as a representative payee should the need arise in the future. Section 201(j)(2) of the Act provides the requirements for selecting a qualified representative payee. SSA only offers the option to advance designate to capable adults and emancipated minors. Beneficiaries who have an assigned representative payee, or have a representative application in process, cannot advance designate. Form SSA–4547, Advance Designation of Representative Payee, allows beneficiaries or applicants the option to designate individuals in order of priority, to serve as a representative. Beneficiaries or applicants can update or change the advance designee order of priority at any time. SSA uses the information on Form SSA–4547 to select a qualified representative payee in order of priority. If the selected representative payee is unable or unwilling to serve, or meet SSA requirements, SSA will select another representative payee to serve in the beneficiaries and applicants best interest. SSA will notify beneficiaries annually of the individuals they chose in advance to be their representative payee. The respondents are SSA beneficiaries and claimants who want to choose an advance designate representative. Type of Request: Request for a new information collection. Frequency of response Total estimated total annual burden (hours) Average burden per response (minutes) SSA–4547—Paper Version ............................................................................. SSA–4547—Intranet version (SSI Claims System; MCS; iMAIN) .................. i4547—Internet version .................................................................................... 85,733 8,451,966 3,201,466 1 1 1 6 6 6 8,573 845,197 320,147 Totals ........................................................................................................ 11,739,165 ........................ ........................ 1,173,917 II. SSA submitted the information collections below to OMB for clearance. Your comments regarding these information collections would be most useful if OMB and SSA receive them 30 days from the date of this publication. To be sure we consider your comments, we must receive them no later than September 12, 2019. Individuals can obtain copies of the OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov. 1. Report to United States Social Security Administration by Person Receiving Benefits for a Child or for an Adult Unable to Handle Funds/Report VerDate Sep<11>2014 17:51 Aug 12, 2019 Jkt 247001 to the United States Social Security Administration—0960–0049. Section 203(c) of the Act requires the Commissioner of SSA to make benefit deductions, and provides for the Commissioner to impose penalty deductions on benefits of individuals who fail to make timely reports of events, which are cause for deductions. SSA uses Forms SSA–7161–OCR–SM and SSA–7162–OCR–SM to: (1) Determine continuing entitlement to Social Security benefits; (2) correct benefit amounts for beneficiaries outside the United States; and (3) monitor the performance of PO 00000 Frm 00102 Fmt 4703 Sfmt 4703 representative payees outside the United States. This collection is mandatory as an annual (or every other year, depending on the country of residence) review for fraud prevention. In addition, the results can affect benefits by increasing or decreasing payment amount or by causing SSA to suspend or terminate benefits. The respondents are individuals living outside the United States who are receiving benefits on their own (or on behalf of someone else) under Title II of the Act. Type of Request: Revision of an OMBapproved information collection. E:\FR\FM\13AUN1.SGM 13AUN1 40122 Federal Register / Vol. 84, No. 156 / Tuesday, August 13, 2019 / Notices Number of respondents Modality of completion Average burden per response (minutes) Estimated total annual burden (hours) SSA–7161–OCR–SM ...................................................................................... SSA–7162–OCR–SM ...................................................................................... 42,314 426,448 1 1 15 5 10,579 35,537 Totals ........................................................................................................ 468,762 ........................ ........................ 46,116 2. Waiver of Your Right to Personal Appearance before an Administrative Law Judge—20 CFR 404.948(b)(l)(i) and 416.1448(b)(l)(i)—0960–0284. Applicants for Social Security, Old Age, Survivors and Disability Insurance (OASDI) benefits and Supplemental Security Income (SSI) payments have the statutory right to appear in person, or through a representative, and present evidence about their claims at a hearing before an administrative law judge (ALJ). If claimants wish to waive this right to appear before an ALJ, they must do so in writing. Form HA–4608 serves as a written waiver for the claimant’s right to a personal appearance before an ALJ. The ALJ uses the information we collect on Form HA–4608 to continue processing the case, and makes the completed form a part of the documentary evidence of record by placing it in the official record of the proceedings as an exhibit. Respondents are applicants or claimants for OASDI and SSI, or their representatives, who request to waive their right to appear in person before an ALJ. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of respondents Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) HA–4608 .......................................................................................................... 12,000 1 2 400 3. Request for Social Security Statement—20 CFR 404.810—0960– 0466. Section 205(c)(2)(A) of the Act requires the Commissioner of SSA to establish and maintain records of wages paid to, and amounts of selfemployment income derived by, each individual as well as the periods in which such wages were paid and such income derived. An individual may complete and mail Form SSA–7004 to SSA to obtain a Statement of Earnings or Quarters of Coverage. SSA uses the information Form SSA–7004 collects to identify respondent’s Social Security earnings records; extract posted earnings information; calculate potential benefit estimates; produce the resulting Social Security statements; and mail them to the requesters. The respondents are Social Security number holders requesting information about their Social Security earnings records and estimates of their potential benefits. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of respondents Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–7004 ........................................................................................................ 60,026 1 5 5,002 4. Function Report—Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday)—20 CFR 416.912 and 416.924a(a)(2)—0960– 0542. As part of SSA’s disability determination process, we use Forms SSA–3375–BK through SSA–3379–BK to request information from a child’s parent or guardian for children applying for SSI. The five different versions of the form contain questions about the child’s jspears on DSK3GMQ082PROD with NOTICES Frequency of response day-to-day functioning appropriate to a particular age group; thus, respondents use only one version of the form for each child. The adjudicative team (disability examiners and medical or psychological consultants) of State disability determination services offices collect the information on the appropriate version of this form (in conjunction with medical and other evidence) to form a complete picture of the children’s ability to function and their impairment-related limitations. The adjudicative team uses the completed profile to determine: (1) If each child’s impairment(s) results in marked and severe functional limitations; and (2) whether each child is disabled. The respondents are parents and guardians of child applicants for SSI. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of respondents Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–3375; SSA-3376; SSA-3377; SSA-3378; SSA–3379 ............................. 579,000 1 20 193,000 5. Private Printing and Modification of Forms—20 CFR 422.527—0960–0663. Prescribed Application and Other 20 CFR 422.527 of the Code of Federal VerDate Sep<11>2014 17:51 Aug 12, 2019 Jkt 247001 PO 00000 Frm 00103 Fmt 4703 Sfmt 4703 Regulations requires a person, institution, or organization (third-party E:\FR\FM\13AUN1.SGM 13AUN1 40123 Federal Register / Vol. 84, No. 156 / Tuesday, August 13, 2019 / Notices entities) to obtain approval from SSA prior to reproducing, duplicating, or privately printing any application or other form the agency owns. To obtain SSA’s approval, entities must make their requests in writing using their company letterhead, providing the required information set forth in the regulation. SSA uses the information to: (1) Ensure requests comply with the law and regulations, and (2) process requests from third-party entities who want to reproduce, duplicate, or privately print any SSA application or other SSA form. SSA employees review the requests and provide approval via email or mail to the third-party entities. The respondents are third-party entities who submit a request to SSA to reproduce, duplicate, or privately print an SSA-owned form. Regulation section Number of respondents Frequency of response Number of responses Average burden per response (minutes) Estimated total annual burden (hours) 20 CFR 422.527 .................................................................. 10 15 150 10 25 6. Letter to Custodian of Birth Records/Letter to Custodian of School Records—20 CFR 404.704, 404.716, 416.802, and 422.107—0960–0693. When individuals need help in obtaining evidence of their age in connection with Social Security number (SSN) card applications and claims for benefits, SSA can prepare the SSA– L106, Letter to Custodian of School Records, or SSA–L706, Letter to Custodian of Birth Records. SSA uses the SSA–L706 to determine the existence of primary evidence of age for SSN applicants. SSA uses both letters to verify with the issuing entity, when necessary, the authenticity of the record submitted by the SSN applicant or claimant. The respondents are schools, State and local bureaus of vital statistics, and religious entities. Type of Request: Revision of an OMBapproved information collection. Number of respondents Modality of completion Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–L106—Private Sector ............................................................................. SSA–L106—State/Local/Tribal Government ................................................... SSA–L706—Private Sector ............................................................................. SSA–L706—State/Local/Tribal Government ................................................... 18 14 429 426 1 1 1 1 10 10 10 10 3 2 72 71 Totals ........................................................................................................ 887 ........................ ........................ 148 7. Application Status—20 CFR 401.45—0960–0763. Application Status provides users with the capability to check the status of their pending Social Security claims via the National 800 Number Automated Telephone Service. Users need their SSN and a confirmation number to access this information. SSA systems determine the jspears on DSK3GMQ082PROD with NOTICES This is a correction notice. SSA published this information collection as a revision on June 4, 2019 at 84 FR 25891. Since we are not making any revisions to this collection, this is now an extension of an OMB-approved information collection. Type of Request: Extension of an OMB-approved information collection. type of claim(s) the caller filed based upon the information provided. Subsequently, the automated telephone system provides callers with the option to choose the claim for which they wish to obtain status. If the caller applied for multiple claims, the automated system allows the caller to select only one claim at a time. Once callers select the claim(s) they are calling about, an automated voice advises them of the status of their claim. The respondents are current Social Security claimants who wish to check on the status of their claims. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of respondents Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) Application Status—Automated Telephone System ........................................ 248,485 1 3 12,424 8. Government-to-Government Services Online Website Registration Form; Government-to-Government Services Online Website Account Modification/Deletion Form—20 CFR 401.45—0960–0757. The Governmentto-Government Services Online (GSO) website allows various external organizations to submit files to a variety of SSA systems and, in some cases, VerDate Sep<11>2014 17:51 Aug 12, 2019 Jkt 247001 receive files in return. The SSA systems that process data transferred via GSO include, but are not limited to, systems responsible for disability processing and benefit determination or termination. SSA uses the information on Form SSA–159, Government-to-Government Online website Registration Form, to register the requestor to use the GSO website. Once we receive the SSA–159, PO 00000 Frm 00104 Fmt 4703 Sfmt 4703 SSA provides the user with account information and conducts a walkthrough of the GSO website as necessary. Established organizations may submit Form SSA–159 to register additional users as well. The established requesting organizations can also complete Form SSA–160, Governmentto-Government Online website Account Modification/Deletion Form, to modify E:\FR\FM\13AUN1.SGM 13AUN1 40124 Federal Register / Vol. 84, No. 156 / Tuesday, August 13, 2019 / Notices their online accounts (e.g., address change). Respondents are State and local government agencies, and some private sector business entities. Number of respondents Modality of completion Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–159 .......................................................................................................... SSA–160 .......................................................................................................... 1,151 410 1 1 15 15 288 103 Totals ........................................................................................................ 1,561 ........................ ........................ 391 9. Evidence From Excluded Medical Sources of Evidence—20 CFR 404.1503b and 416.903b—0960–0803. Pursuant to its broad authority to regulate under sections 205(a), 702(a)(5), and 1631(d)(1) of the Act, SSA implemented section 223(d)(5)(C), as amended, through regulations at 20 CFR 404.1503b and 416.903b. These regulations require excluded medical sources to self-report their excluded status in writing each time they submit evidence related to a claim for benefits under Titles II or XVI of the Act. Excluded medical sources’ duty to selfreport their excluded status apply to evidence they submit to SSA directly or through a representative, claimant, or other individual or entity. The respondents for this collection are medical sources that: (1) Meet one of the exclusionary categories set forth in section 223(d)(5)(C)(i) of the Act, as amended; and (2) furnish evidence related to a claim for benefits under Titles II or XVI of the Act. Type of Request: Revision of an OMBapproved information collection. Regulation section(s) Number of respondents Frequency of response Number of responses Average burden per response (minutes) Estimated total annual burden (hours) 404.1503b(c), 416.903b(c) ................................................... 50 60 3,000 20 1,000 Dated: August 8, 2019. Naomi Sipple, Reports Clearance Officer, Social Security Administration. these determinations be published in the Federal Register. DEPARTMENT OF STATE Chi Tran, Paralegal Specialist, Office of the Legal Adviser, U.S. Department of State (telephone: 202–632–6471; email: section2459@state.gov). The mailing address is U.S. Department of State, L/ PD, SA–5, Suite 5H03, Washington, DC 20522–0505. [Delegation of Authority No. 474] FOR FURTHER INFORMATION CONTACT: [FR Doc. 2019–17281 Filed 8–12–19; 8:45 am] BILLING CODE 4191–02–P DEPARTMENT OF STATE [Public Notice 10843] The foregoing determinations were made pursuant to the authority vested in me by the Act of October 19, 1965 (79 Stat. 985; 22 U.S.C. 2459), Executive Order 12047 of March 27, 1978, the Foreign Affairs Reform and Restructuring Act of 1998 (112 Stat. 2681, et seq.; 22 U.S.C. 6501 note, et seq.), Delegation of Authority No. 234 of October 1, 1999, and Delegation of Authority No. 236–3 of August 28, 2000. SUPPLEMENTARY INFORMATION: Notice of Determinations; Culturally Significant Objects Imported for Exhibition—Determinations: ‘‘Lari Pittman: Declaration of Independence’’ Exhibition jspears on DSK3GMQ082PROD with NOTICES Type of Request: Revision of an OMBapproved information collection. SUMMARY: Notice is hereby given of the following determinations: I hereby determine that certain objects to be included in the exhibition ‘‘Lari Pittman: Declaration of Independence,’’ imported from abroad for temporary exhibition within the United States, are of cultural significance. The objects are imported pursuant to a loan agreement with the foreign owner or custodian. I also determine that the exhibition or display of the exhibit objects at the Hammer Museum, Los Angeles, California, from on or about September 29, 2019, until on or about January 5, 2020, and at possible additional exhibitions or venues yet to be determined, is in the national interest. I have ordered that Public Notice of VerDate Sep<11>2014 17:51 Aug 12, 2019 Jkt 247001 Marie Therese Porter Royce, Assistant Secretary, Bureau of Educational and Cultural Affairs, Department of State. [FR Doc. 2019–17335 Filed 8–12–19; 8:45 am] BILLING CODE 4710–05–P PO 00000 Frm 00105 Fmt 4703 Sfmt 4703 Delegation of Authority To Concur With Decisions by the Secretary of Energy To Enter Into Agreements Relating to Contributions for Certain Nonproliferation Programs By virtue of the authority vested in the Secretary of State, including section 1 of the State Department Basic Authorities Act, as amended (22 U.S.C. 2651a), and to the extent authorized by law, I hereby delegate to the Under Secretary for Arms Control and International Security the authority to concur with decisions by the Secretary of Energy to enter into agreements relating to contributions for certain Department of Energy nonproliferation programs, as described in 50 U.S.C. 2569(f). The Secretary or the Deputy Secretary may at any time exercise any authority or function delegated by this delegation of authority. Any act, authority, or procedure subject to, or affected by, this delegation shall be deemed to be such act, authority, or procedure as amended from time to time. This delegation of authority shall be published in the Federal Register. E:\FR\FM\13AUN1.SGM 13AUN1

Agencies

[Federal Register Volume 84, Number 156 (Tuesday, August 13, 2019)]
[Notices]
[Pages 40121-40124]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-17281]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2019-0034]


Agency Information Collection Activities: Proposed Request and 
Comment Request

    The Social Security Administration (SSA) publishes a list of 
information collection packages requiring clearance by the Office of 
Management and Budget (OMB) in compliance with Public Law 104-13, the 
Paperwork Reduction Act of 1995, effective October 1, 1995. This notice 
includes one new, one extension, and revisions of OMB-approved 
information collections.
    SSA is soliciting comments on the accuracy of the agency's burden 
estimate; the need for the information; its practical utility; ways to 
enhance its quality, utility, and clarity; and ways to minimize burden 
on respondents, including the use of automated collection techniques or 
other forms of information technology. Mail, email, or fax your 
comments and recommendations on the information collection(s) to the 
OMB Desk Officer and SSA Reports Clearance Officer at the following 
addresses or fax numbers.

(OMB) Office of Management and Budget, Attn: Desk Officer for SSA, Fax: 
202-395-6974, Email address: [email protected].
(SSA) Social Security Administration, OLCA, Attn: Reports Clearance 
Director, 3100 West High Rise, 6401 Security Blvd., Baltimore, MD 
21235, Fax: 410-966-2830, Email address: [email protected].

    Or you may submit your comments online through www.regulations.gov, 
referencing Docket ID Number [SSA-2019-0034].
    I. The information collection below is pending at SSA. SSA will 
submit it to OMB within 60 days from the date of this notice. To be 
sure we consider your comments, we must receive them no later than 
October 15, 2019. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    Advance Representative Payee Representative Payee Supporting 
Statement for Advance Designation of Representative Payee--0960-NEW. On 
April 13, 2018, the President signed into law The Strengthening 
Protections for Social Security Beneficiaries Act of 2018, also known 
as Public Law 115-165. Section 201 of the law allows SSA beneficiaries 
and applicants under Title II, Title VIII and Title XVI, of the Social 
Secuirty Act (Act) to designate individuals to serve as a 
representative payee should the need arise in the future. Section 
201(j)(2) of the Act provides the requirements for selecting a 
qualified representative payee. SSA only offers the option to advance 
designate to capable adults and emancipated minors. Beneficiaries who 
have an assigned representative payee, or have a representative 
application in process, cannot advance designate. Form SSA-4547, 
Advance Designation of Representative Payee, allows beneficiaries or 
applicants the option to designate individuals in order of priority, to 
serve as a representative. Beneficiaries or applicants can update or 
change the advance designee order of priority at any time. SSA uses the 
information on Form SSA-4547 to select a qualified representative payee 
in order of priority. If the selected representative payee is unable or 
unwilling to serve, or meet SSA requirements, SSA will select another 
representative payee to serve in the beneficiaries and applicants best 
interest. SSA will notify beneficiaries annually of the individuals 
they chose in advance to be their representative payee. The respondents 
are SSA beneficiaries and claimants who want to choose an advance 
designate representative.
    Type of Request: Request for a new information collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                       Total
                                                     Number of     Frequency of   Average burden     estimated
             Modality of completion                  responses       response      per response    total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4547--Paper Version.........................          85,733               1               6           8,573
SSA-4547--Intranet version (SSI Claims System;         8,451,966               1               6         845,197
 MCS; iMAIN)....................................
i4547--Internet version.........................       3,201,466               1               6         320,147
                                                 ---------------------------------------------------------------
    Totals......................................      11,739,165  ..............  ..............       1,173,917
----------------------------------------------------------------------------------------------------------------

    II. SSA submitted the information collections below to OMB for 
clearance. Your comments regarding these information collections would 
be most useful if OMB and SSA receive them 30 days from the date of 
this publication. To be sure we consider your comments, we must receive 
them no later than September 12, 2019. Individuals can obtain copies of 
the OMB clearance packages by writing to [email protected].
    1. Report to United States Social Security Administration by Person 
Receiving Benefits for a Child or for an Adult Unable to Handle Funds/
Report to the United States Social Security Administration--0960-0049. 
Section 203(c) of the Act requires the Commissioner of SSA to make 
benefit deductions, and provides for the Commissioner to impose penalty 
deductions on benefits of individuals who fail to make timely reports 
of events, which are cause for deductions. SSA uses Forms SSA-7161-OCR-
SM and SSA-7162-OCR-SM to: (1) Determine continuing entitlement to 
Social Security benefits; (2) correct benefit amounts for beneficiaries 
outside the United States; and (3) monitor the performance of 
representative payees outside the United States. This collection is 
mandatory as an annual (or every other year, depending on the country 
of residence) review for fraud prevention. In addition, the results can 
affect benefits by increasing or decreasing payment amount or by 
causing SSA to suspend or terminate benefits. The respondents are 
individuals living outside the United States who are receiving benefits 
on their own (or on behalf of someone else) under Title II of the Act.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 40122]]



----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
             Modality of completion                  Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7161-OCR-SM.................................          42,314               1              15          10,579
SSA-7162-OCR-SM.................................         426,448               1               5          35,537
                                                 ---------------------------------------------------------------
    Totals......................................         468,762  ..............  ..............          46,116
----------------------------------------------------------------------------------------------------------------

    2. Waiver of Your Right to Personal Appearance before an 
Administrative Law Judge--20 CFR 404.948(b)(l)(i) and 
416.1448(b)(l)(i)--0960-0284. Applicants for Social Security, Old Age, 
Survivors and Disability Insurance (OASDI) benefits and Supplemental 
Security Income (SSI) payments have the statutory right to appear in 
person, or through a representative, and present evidence about their 
claims at a hearing before an administrative law judge (ALJ). If 
claimants wish to waive this right to appear before an ALJ, they must 
do so in writing. Form HA-4608 serves as a written waiver for the 
claimant's right to a personal appearance before an ALJ. The ALJ uses 
the information we collect on Form HA-4608 to continue processing the 
case, and makes the completed form a part of the documentary evidence 
of record by placing it in the official record of the proceedings as an 
exhibit. Respondents are applicants or claimants for OASDI and SSI, or 
their representatives, who request to waive their right to appear in 
person before an ALJ.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Estimated total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
HA-4608.....................................          12,000                1                2              400
----------------------------------------------------------------------------------------------------------------

    3. Request for Social Security Statement--20 CFR 404.810--0960-
0466. Section 205(c)(2)(A) of the Act requires the Commissioner of SSA 
to establish and maintain records of wages paid to, and amounts of 
self-employment income derived by, each individual as well as the 
periods in which such wages were paid and such income derived. An 
individual may complete and mail Form SSA-7004 to SSA to obtain a 
Statement of Earnings or Quarters of Coverage. SSA uses the information 
Form SSA-7004 collects to identify respondent's Social Security 
earnings records; extract posted earnings information; calculate 
potential benefit estimates; produce the resulting Social Security 
statements; and mail them to the requesters. The respondents are Social 
Security number holders requesting information about their Social 
Security earnings records and estimates of their potential benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Estimated total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7004....................................          60,026                1                5            5,002
----------------------------------------------------------------------------------------------------------------

    4. Function Report--Child (Birth to 1st Birthday, Age 1 to 3rd 
Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th 
Birthday)--20 CFR 416.912 and 416.924a(a)(2)--0960-0542. As part of 
SSA's disability determination process, we use Forms SSA-3375-BK 
through SSA-3379-BK to request information from a child's parent or 
guardian for children applying for SSI. The five different versions of 
the form contain questions about the child's day-to-day functioning 
appropriate to a particular age group; thus, respondents use only one 
version of the form for each child. The adjudicative team (disability 
examiners and medical or psychological consultants) of State disability 
determination services offices collect the information on the 
appropriate version of this form (in conjunction with medical and other 
evidence) to form a complete picture of the children's ability to 
function and their impairment-related limitations. The adjudicative 
team uses the completed profile to determine: (1) If each child's 
impairment(s) results in marked and severe functional limitations; and 
(2) whether each child is disabled. The respondents are parents and 
guardians of child applicants for SSI.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Estimated total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3375; SSA[dash]3376; SSA[dash]3377;              579,000                1               20          193,000
 SSA[dash]3378; SSA-3379....................
----------------------------------------------------------------------------------------------------------------

    5. Private Printing and Modification of Prescribed Application and 
Other Forms--20 CFR 422.527--0960-0663. 20 CFR 422.527 of the Code of 
Federal Regulations requires a person, institution, or organization 
(third-party

[[Page 40123]]

entities) to obtain approval from SSA prior to reproducing, 
duplicating, or privately printing any application or other form the 
agency owns. To obtain SSA's approval, entities must make their 
requests in writing using their company letterhead, providing the 
required information set forth in the regulation. SSA uses the 
information to: (1) Ensure requests comply with the law and 
regulations, and (2) process requests from third-party entities who 
want to reproduce, duplicate, or privately print any SSA application or 
other SSA form. SSA employees review the requests and provide approval 
via email or mail to the third-party entities. The respondents are 
third-party entities who submit a request to SSA to reproduce, 
duplicate, or privately print an SSA-owned form.
    This is a correction notice. SSA published this information 
collection as a revision on June 4, 2019 at 84 FR 25891. Since we are 
not making any revisions to this collection, this is now an extension 
of an OMB-approved information collection.
    Type of Request: Extension of an OMB-approved information 
collection.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                         Average burden  Estimated total
                         Regulation section                             Number of       Frequency of      Number of       per response    annual burden
                                                                       respondents        response        responses        (minutes)         (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 CFR 422.527.....................................................              10               15              150               10               25
--------------------------------------------------------------------------------------------------------------------------------------------------------

    6. Letter to Custodian of Birth Records/Letter to Custodian of 
School Records--20 CFR 404.704, 404.716, 416.802, and 422.107--0960-
0693. When individuals need help in obtaining evidence of their age in 
connection with Social Security number (SSN) card applications and 
claims for benefits, SSA can prepare the SSA-L106, Letter to Custodian 
of School Records, or SSA-L706, Letter to Custodian of Birth Records. 
SSA uses the SSA-L706 to determine the existence of primary evidence of 
age for SSN applicants. SSA uses both letters to verify with the 
issuing entity, when necessary, the authenticity of the record 
submitted by the SSN applicant or claimant. The respondents are 
schools, State and local bureaus of vital statistics, and religious 
entities.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L106--Private Sector........................              18               1              10               3
SSA-L106--State/Local/Tribal Government.........              14               1              10               2
SSA-L706--Private Sector........................             429               1              10              72
SSA-L706--State/Local/Tribal Government.........             426               1              10              71
                                                 ---------------------------------------------------------------
    Totals......................................             887  ..............  ..............             148
----------------------------------------------------------------------------------------------------------------

    7. Application Status--20 CFR 401.45--0960-0763. Application Status 
provides users with the capability to check the status of their pending 
Social Security claims via the National 800 Number Automated Telephone 
Service. Users need their SSN and a confirmation number to access this 
information. SSA systems determine the type of claim(s) the caller 
filed based upon the information provided. Subsequently, the automated 
telephone system provides callers with the option to choose the claim 
for which they wish to obtain status. If the caller applied for 
multiple claims, the automated system allows the caller to select only 
one claim at a time. Once callers select the claim(s) they are calling 
about, an automated voice advises them of the status of their claim. 
The respondents are current Social Security claimants who wish to check 
on the status of their claims.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden     Estimated
           Modality of completion                Number of       Frequency of    per  response     total annual
                                                respondents        response        (minutes)     burden  (hours)
----------------------------------------------------------------------------------------------------------------
Application Status--Automated Telephone              248,485                1                3           12,424
 System.....................................
----------------------------------------------------------------------------------------------------------------

    8. Government-to-Government Services Online Website Registration 
Form; Government-to-Government Services Online Website Account 
Modification/Deletion Form--20 CFR 401.45--0960-0757. The Government-
to-Government Services Online (GSO) website allows various external 
organizations to submit files to a variety of SSA systems and, in some 
cases, receive files in return. The SSA systems that process data 
transferred via GSO include, but are not limited to, systems 
responsible for disability processing and benefit determination or 
termination. SSA uses the information on Form SSA-159, Government-to-
Government Online website Registration Form, to register the requestor 
to use the GSO website. Once we receive the SSA-159, SSA provides the 
user with account information and conducts a walkthrough of the GSO 
website as necessary. Established organizations may submit Form SSA-159 
to register additional users as well. The established requesting 
organizations can also complete Form SSA-160, Government-to-Government 
Online website Account Modification/Deletion Form, to modify

[[Page 40124]]

their online accounts (e.g., address change). Respondents are State and 
local government agencies, and some private sector business entities.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-159.........................................           1,151               1              15             288
SSA-160.........................................             410               1              15             103
                                                 ---------------------------------------------------------------
    Totals......................................           1,561  ..............  ..............             391
----------------------------------------------------------------------------------------------------------------

    9. Evidence From Excluded Medical Sources of Evidence--20 CFR 
404.1503b and 416.903b--0960-0803. Pursuant to its broad authority to 
regulate under sections 205(a), 702(a)(5), and 1631(d)(1) of the Act, 
SSA implemented section 223(d)(5)(C), as amended, through regulations 
at 20 CFR 404.1503b and 416.903b. These regulations require excluded 
medical sources to self-report their excluded status in writing each 
time they submit evidence related to a claim for benefits under Titles 
II or XVI of the Act. Excluded medical sources' duty to self-report 
their excluded status apply to evidence they submit to SSA directly or 
through a representative, claimant, or other individual or entity. The 
respondents for this collection are medical sources that: (1) Meet one 
of the exclusionary categories set forth in section 223(d)(5)(C)(i) of 
the Act, as amended; and (2) furnish evidence related to a claim for 
benefits under Titles II or XVI of the Act.
    Type of Request: Revision of an OMB-approved information 
collection.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                        Average  burden     Estimated
                       Regulation section(s)                            Number of       Frequency of      Number of      per  response     total annual
                                                                       respondents        response        responses        (minutes)     burden  (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
404.1503b(c), 416.903b(c)..........................................              50               60            3,000               20            1,000
--------------------------------------------------------------------------------------------------------------------------------------------------------


    Dated: August 8, 2019.
Naomi Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2019-17281 Filed 8-12-19; 8:45 am]
BILLING CODE 4191-02-P